Tackle health inequalities to reduce Northern Ireland’s teen suicide and avoidable infant death rate, say leading doctors and campaigners
Children’s doctors and child rights campaigners are calling on policy makers to address health inequalities and introduce a series of public health measures in a bid to reduce avoidable child deaths in Northern Ireland. The call comes as the Royal College of Paediatrics and Child Health (RCPCH) and the National Children’s Bureau NI (NCB NI) publish a series of recommendations on reducing child mortality in its report ‘Why children die – Part E’.
According to the report, 182 children and young people under the age of 19 died in Northern Ireland (2012). It highlights that Northern Ireland has the highest infant mortality rate* (babies under the age of one) in the UK with nearly half (49%) of all deaths occurring in this age group. Many of these deaths can be avoided through reducing incidence of preterm birth and low birth weight, risk factors which disproportionally affect the most disadvantaged in society.
Teens aged between 15 and 19 are the second most at-risk group for child deaths in Northern Ireland (29%), with suicide, self-harm or assault being the leading causes. The number of deaths has been increasing steadily over the last 10 years with deprivation thought to be a considerable risk factor.
The ‘Why children die’ report reviews existing evidence and highlights how:
- Smoking is a high risk factor for adverse outcomes so interventions to reduce smoking during pregnancy should continue to be prioritised. For example, the introduction of carbon monoxide screening along with reinforcement of smoking cessation public health messages. In 2012, 16% of mothers in Northern Ireland smoked during pregnancy. This figure is higher for mothers under 20 (37%) and for mothers who live in areas of deprivation (29%).
- Breastfeeding has an important protective role for infants born preterm. Despite breastfeeding rates doubling in Northern Ireland over the past 20 years, Northern Ireland has the lowest rate of breastfeeding in the UK. Therefore a focus must be on providing consistent, targeted breastfeeding support and education with particular emphasis on young mothers and those living in areas of higher deprivation1.
- There must be a focus on improved service provision for those children most at risk of mental health difficulties. Suicide rates in Northern Ireland have been steadily increasing over the last 10 years, with rates in the most deprived areas of the country having more than tripled2.
- Road safety must be heightened with the implementation of 20mph speed restrictions and graduated licensing schemes. Children have been highlighted as being particularly vulnerable to road traffic accidents with injury mortality rate for boys in Northern Ireland being historically much higher than across the rest of the UK – 11.53 in England compared to 20.85 in Northern Ireland (between 2006-2010)3.
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Dr Julie-Ann Maney of the Royal College of Paediatrics and Child Health and member of the ‘Why children die’ Advisory Group, said:
“Whilst there is a lot of good on-going work on reducing child mortality in Northern Ireland, our current mortality rates not only identify us as one of the worst performing countries in Europe, but also the worst in the UK.
“Northern Ireland’s increasing teen suicide rate is a huge area of concern. We must ensure that all professionals who work with children have basic mental health awareness. This will allow them to identify ‘at risk’ children early and maximise the potential to intervene before the child’s mental health deteriorates further.”
Celine McStravick, Director of NCB NI, said:
“All children and young people in Northern Ireland must be able to play, learn and grow in safety and security; yet 22% of our children live in poverty, and continued inequality of access to crucial services across NI means that some children have a much better start in life than others. A fit for purpose Child Poverty Strategy is essential if the NI government is to tackle the very real health inequalities evident across the region.
“There is a wealth of good work ongoing across Northern Ireland, with a particular focus on the period of conception to three years where much can be done to prevent premature births and reduce the risk of children dying early. There is also an increasing focus on the need to intervene early at later life stages where issues such as mental health, drug and alcohol misuse may lead to premature death.
“This report acknowledges the good practice ongoing, but highlights the need for a more coordinated, preventative approach to ensure all children and young people have the best possible opportunity to live long and healthy lives.”
The ‘Why Children Die’ report also says that figures will not improve unless other measures are put in place. These include:
- Consistent delivery of Relationships and Sexuality Education in schools so young people can make informed decisions about their health and are taught about the importance of healthy behaviours during pregnancy
- Taking further steps to restrict access to alcohol by children and young people, including progressing with the introduction of a minimum price per unit, regulation of marketing and action on under-age sales
- Wide-reaching awareness campaign to promote safe-sleeping and raise awareness of the risks of co-sleeping
- Prioritising long term investments in maternal and child health services including a review of existing universal maternity and health visiting services and continued roll out of appropriate evidence based parenting support programmes across Northern Ireland
- Commission a regular mental health survey which looks at prevalence among children and young people in Northern Ireland
- Routine carbon monoxide screening for pregnant women
- Undertaking a review of Road Safety Education services to ensure that they appropriately address today’s road safety issues
Dr Julie-Ann Maney continues:
“If we are to reduce these rates, it is crucial that we examine closely why each death occurred so we can then look at ways to target prevention. That’s why a Child Death Overview Panel, as already in place in other parts of the UK, must be established.
“Let me be clear – one preventable child death is one too many. So I call on policy makers to make a series of changes including making our streets safer, improving mental health training and improving stop smoking support so children have the opportunity to survive and lead a healthy life.”
Download a copy of the ‘Why Children Die-Part A’ and ‘Why Children Die – Part E’ (Northern Ireland) report by visiting the RCPCH’s website.
*Infant mortality rates in Northern Ireland tend to be higher than other parts of the UK, however given the smaller number of births and deaths it is difficult to draw any definitive conclusions about this difference. Further research and investigation is required.
1 Initial breastfeeding rates in 2010 were 64% compared to 83% in England, 74% in Scotland and 71% in Wales. This figure is lower for younger mothers and mothers living in areas of deprivation.
2 There were 69 deaths of young people aged between 15 and 19 due to suicide in Northern Ireland. Of these, 78% were males and 22% female (2010-2013).
3 Higher incidences of death and serious injury have also been found amongst young drivers (16-24) and those within rural and deprived areas.
Source: The Royal College of Paediatrics and Child Health (RCPCH) and NCB NI